On Trees and Barking: How to Select the Right Tree and Get Diagnosed

 I have a close friend struggling with some gnarly health issues and they've been banging their head against the wall of the same specialty for a while now with nothing to show for it.

My advice to them was to look at what other body system or issue could cause their symptoms as clearly the specialty they were seeing wasn't helping. I have found, through bitter experience, that when you've thoroughly tested one system and come up empty but still have symptoms, it means you're looking at the wrong body system and seeing the wrong specialty.

Don't keep running the same tests and seeing the same specialty if you're coming up empty. Think bigger. Talk to patients. Try Google searches combining your most unique, specific symptoms with other organs and body systems.

For example: Can skin/heart/liver/thyroid etc... disease cause XYZ?  Or, skin/heart/liver/thyroid etc... disease + XYZ symptoms.  

This ended up being relevant for the teen as well, but it took us longer to figure it out because her big symptom is also considered pretty common...it didn't become specific until we went through a bunch of different medications and even then it was confusing because medicine has a long tradition of denying that this issue is abnormal, there's a lot of cultural bias with it. 

Things had to get so extra that even the doctors were going WTF? Also, they did screen for the most common disorders and we erroneously thought that we'd ruled it all out...we didn't know about other, less common categories of dysfunction and testing to even ask for them. We didn't know they hadn't looked at the super rare shit. (We were way beyond my experience and education on this one. It even took me a while to catch on. Believe it or not, we ended up in an area of medicine that wasn't in the premed classes I took back in ancient times. I wasn't pleased to discover that a lot of this stuff had been missing. )

Don't assume because your symptoms look like they're in one body system, that they're coming from that same body system. They might not be. And make sure you understand the full menu of testing options and the full spectrum of disorders. Basic screenings are basic. Intermediate screenings are intermediate.

 You're probably not getting all the testing possible. You access it in phases. One round of testing doesn't rule out everything. There's always another level of testing. Always. What is amazing to me is how many doctors see normal results from the basic or intermediate level testing and go 'welp, nothing else to see here, you're fine, go home' instead of coming to the conclusion that it's time to go zebra hunting. 

You have GI symptoms but the ultrasound is clear? You're fine, go home.

You have GI symptoms but the CT is clear? You're fine, go home.

You have new tumors on CT, a fever, and can't eat? You're fine, go home.

I've done this dance a lot. Now my kid has too. 

I mean, when there's a fire, the fire department doesn't throw some water on it and call it done even though the fire keeps burning. They keep going. They figure out why the water isn't working. They look at what substances might be on fire. Doctors give up though. They don't care what's on fire. They threw a small, wholly inadequate pail of water on you and whatever is still on fire after that is pronounced fine. 

YOU the patient have to see all the blindspots where horses and zebras hide and make sure to point them out to doctors. Patients can't rely on doctors to see anything at all.